[1]封建华,叶建明,赵 毅,等.终末期肾病维持性血液透析患者血清SORT 和IGF-1 水平表达与心血管疾病发生及预后的相关性研究[J].现代检验医学杂志,2024,39(03):125-130.[doi:10.3969/j.issn.1671-7414.2024.03.021]
　FENG Jianhua,YE Jianming,ZHAO Yi,et al.Correlation among the Expression of Serum SORT and IGF-1 Levels in Maintenance Hemodialysis Patients with End Stage Renal Disease and the Occurrence and Prognosis of Cardiovascular Diseases[J].Journal of Modern Laboratory Medicine,2024,39(03):125-130.[doi:10.3969/j.issn.1671-7414.2024.03.021]
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终末期肾病维持性血液透析患者血清SORT 和IGF-1 水平表达与心血管疾病发生及预后的相关性研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年03期
页码:
125-130
栏目:
论著
出版日期:
2024-05-15

文章信息/Info

Title:
Correlation among the Expression of Serum SORT and IGF-1 Levels in Maintenance Hemodialysis Patients with End Stage Renal Disease and the Occurrence and Prognosis of Cardiovascular Diseases
文章编号:
1671-7414（2024）03-125-06
作者:
封建华; 叶建明; 赵 毅; 郁丽霞
（昆山市第一人民医院肾脏内科，江苏昆山 215300）
Author(s):
FENG Jianhua;  YE Jianming;  ZHAO Yi;  YU Lixia
(Department of Nepehrology, the First People’s Hospital of Kunshan, Jiangsu Kunshan 215300, China)
关键词:
维持性血液透析; Sortilin; 胰岛素样生长因子-1; 心血管疾病
分类号:
R692.5；R54；R392.11
DOI:
10.3969/j.issn.1671-7414.2024.03.021
文献标志码:
A
摘要:
目的 探讨终末期肾病(end-stage renal disease，ESRD) 维持性血液透析(maintenance hemodialysis，MHD) 患者血清Sortilin（SORT）、胰岛素样生长因子-1（insulin-like growth factor 1，IGF-1）水平与心血管疾病（cardiovasculardisease，CVD）发生和预后的相关性。方法 选取2017 年2 月~2018 年2 月昆山市第一人民医院诊治的84 例终末期肾病MHD 患者为MHD 组。随访5 年，根据是否并发CVD 将MHD 组分为CVD 组（n=35）和非CVD 组（n=49），以同期体检的60 例健康人为对照组。酶联免疫吸附实验（ELISA）法检测血清SORT 和IGF-1 水平。多因素Logistic 回归分析终末期肾病MHD 患者并发CVD 的影响因素。受试者工作特征(ROC) 曲线分析血清SORT 和IGF-1 对终末期肾病MHD患者并发CVD的预测价值。Kaplan-Meier 生存分析血清SORT，IGF-1 水平与终末期肾病MHD患者生存率的相关性。结果 相比于对照组，MHD组血清SORT 水平（413.37 ± 55.41 ng/L vs 81.27 ± 24.69 ng/L）较高，血清IGF-1 水平（117.64± 18.42 μg/L vs 421.34 ± 14.58 μg/L）较低，差异具有统计学意义（t=43.416，106.122，均P<0.001）。CVD 组患者年龄、透析时间、血清SORT（488.73 ± 55.41 ng/L vs 359.54 ± 58.29 ng/L）高于非CVD 组，血清IGF-1（88.25 ± 17.92 μg/L vs 138.63 ± 19.55 μg/L）低于非CVD 组，差异具有统计学意义(t=2.896, 2.588, 10.221, 12.050，均P<0.05）。年龄（OR=1.548，P<0.001）、透析时间（OR=1.616，P<0.001）和血清SORT（OR=1.353，P=0.000）是影响MHD 患者并发CVD 的独立危险因素，血清IGF-1（OR=0.742，P<0.001）是保护因素。血清SORT 和IGF-1 联合检测预测MHD 患者并发CVD 的曲线下面积（95%CI）为0.931（0.895~0.961），大于SORT 和IGF-1 单项指标检测[0.843（0.810~0.889），0.887（0.833~0.921）]，差异具有统计学意义（Z=5.117，4.895，均P ＜ 0.001）。SORT 高表达组MHD 患者五年累积生存率（48.39%）低于低表达组（84.81%），IGF-1 低表达组MHD患者五年累积生存率（51.52%）低于高表达组（84.31%），差异具有统计学意义（Log-Rank χ2=18.670，8.900，均P<0.01）。结论 MHD患者血清SORT 水平升高，IGF-1 水平降低，两者联合检测对终末期肾病MHD 患者CVD 的发生具有较高的预测价值，与终末期肾病MHD 患者不良生存预后相关。
Abstract:
Objective To investigate the correlation between serum Sortilin (SORT) and insulin-like growth factor 1 (IGF-1) levels and the occurrence and prognosis of cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients with endstage renal disease(ESRD). Methods Eighty-four MHD patients with ESRD diagnosed and treated in the First People’s Hospital of Kunshan from February 2017 to February 2018 were selected as the MHD group. With 5 years of follow-up, the MHD group was divided into the CVD group (n=35) and the non-CVD group (n=49) according to whether they had concurrent CVD, while 60 healthy individuals who underwent physical examination during the same period were used as the control group. Enzymelinked immunosorbent assay was used to detect serum SORT and IGF-1 levels. Multivariate logistic regression analysis was conducted to investigate the influencing factors of CVD in MHD patients with ESRD. The predictive value of serum SORT and IGF-1 for CVD in MHD patients with ESRD was analyzed by the receiver operating characteristic curve. The correlation between serum SORT and IGF-1 levels and the survival rate of MHD patients with ESRD was analyzed by Kaplan-Meier survival analysis. Results Compared to the control group, the MHD group had higher serum SORT level (413.37 ± 55.41 ng/L vs 81.27 ± 24.69 ng/L) and lower serum IGF-1 level(117.64 ± 18.42 μg/L vs 421.34 ± 14.58 μg/L), with significant differences (t=43.416,106.122, all P<0.001). The age, dialysis time, and serum SORT level(488.73 ± 55.41ng/L vs 359.54 ± 58.29ng/L) of patients in the CVD group were higher than those in the non-CVD group, while serum IGF-1 level(88.25 ± 17.92 μg/L vs 138.63 ± 19.55 μg/L) was lower than that of the non-CVD group, with significant differences (t=2.896, 2.588, 10.221, 12.050, all P<0.05). Age (OR=1.548, P<0.001), dialysis time (OR=1.616, P<0.001) and serum SORT (OR=1.353, P<0.001) were independent risk factors for CVD in MHD patients, while serum IGF-1 (OR=0.742, P=0.000) was a protective factor for CVD in MHD patients. The area under the curve (95%CI) of the combined serum SORT and IGF-1 test for predicting concomitant CVD in MHD patients was 0.931 (95% CI: 0.895~0.961), which was greater than that of the single detection [0.843 (0.810~0.889), 0.887 (0.833~0.921)], and the differences were statistically significant (Z=5.117, 4.895, all P<0.001). The five-year cumulative survival rate of MHD patients in the SORT high expression group (48.39%) was lower than that in the low expression group (84.81%), while the fiveyear cumulative survival rate of MHD patients in the IGF-1 low expression group (51.52%) was lower than that in the high expression group (84.31%), and the differences were significant (Log-Rank χ2=18.670, 8.900, all P<0.01). Conclusion The serum SORT levels increased while IGF-1 levels decreased in MHD patients. The combined detection of the two has high predictive value for the occurrence of CVD in MHD patients with ESRD, which is associated with poor survival prognosis in MHD patients with ESRD.

参考文献/References:

[1] WANG Limin, XU Xin, ZHANG Mei, et al. Prevalence of chronic kidney disease in China: results from the sixth China chronic disease and risk factor surveillance[J]. JAMA Internal Medicine, 2023, 183(4):298-310.
[2] YANG Chao, YANG Zhao, WANG Jinwei, et al. Estimation of prevalence of kidney disease treated with dialysis in China: a study of insurance claims data[J].American Journal of Kidney Diseases, 2021, 77(6):889-897.e1.
[3] HUANG Shihting, YU Tungmin, CHEN Chiahsin, et al. Risk of major cardiovascular disease after exposure to contrast media: a nationwide Population-Based cohort study on dialysis patients[J]. Metabolites, 2023,13(2): 266.
[4] GOETTSCH C, KJOLBY M, AIKAWA E. Sortilin and its multiple roles in cardiovascular and metabolic diseases[J]. Arteriosclerosis, Thrombosis, and Vascular Biology, 2018, 38(1): 19-25.
[5] M?LLER P L, ROHDE P D, WINTHER S, et al. Sortilin as a biomarker for cardiovascular disease revisited[J]. Frontiers in Cardiovascular Medicine,2021, 8: 652584.
[6] LARSSON S C, MICHA?LSSON K, BURGESS S. IGF-1 and cardiometabolic diseases: a Mendelian randomisation study[J]. Diabetologia, 2020, 63(9):1775-1782.
[7] LIN Jiayang, YANG Linjie, HUANG Junlin, et al. Insulin-like growth factor 1 and risk of cardiovascular disease: results from the UK biobank cohort study[J].Journal of Clinical Endocrinology and Metabolism,2023, 108(9): e850-e860.
[8] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation,classification, and stratification[J]. American Journal of Kidney Diseases, 2002, 39(2 Suppl 1): S1-266.
[9] WOUK N. End-stage renal disease: medical management[J]. American Family Physician, 2021,104(5): 493-499.
[10] 王淑明, 徐建男, 张建新, 等．维持性血液透析患者血清Beclin1 和LC3- Ⅱ表达水平与血管钙化的相关性分析[J]．现代检验医学杂志, 2022, 37(2): 132-136, 152． WANG Shuming, XU Jiannan, ZHANG Jianxin,et al. Correlation between serum Beclin1 and LC3-Ⅱ expression levels and vascular calcification in maintenance hemodialysis patients[J]. Journal of Modern Laboratory Medicine, 2022, 37(2): 132-136,152.
[11] JANKOWSKI V, SARITAS T, KJOLBY M, et al. Carbamylated sortilin associates with cardiovascular calcification in patients with chronic kidney disease[J].Kidney International, 2022, 101(3): 574-584.
[12] KASPRZAK A. Insulin-like growth factor 1 (IGF-1) signaling in glucose metabolism in colorectal cancer[J].International Journal of Molecular Sciences, 2021,22(12): 6434.
[13] GUNGOR O, ULU S, HASBAL N B, et al. Effects of hormonal changes on sarcopenia in chronic kidney disease: where are we now and what can we do?[J].Journal of Cachexia, Sarcopenia and Muscle, 2021,12(6): 1380-1392.
[14] XU Jie, SHEN Chanjuan, OOI J D, et al. Serum sortilin is associated with coronary artery calcification and cardiovascular and cerebrovascular events in maintenance hemodialysis patients[J]. Kidney Diseases(Basel, Switzerland) , 2021, 7(6): 503-513.
[15] MA Jun, LI Yanan, YANG Xiangyu, et al. Signaling pathways in vascular function and hypertension:molecular mechanisms and therapeutic interventions[J].Signal Transduction and Targeted Therapy, 2023, 8(1):168.
[16] IQBAL F, SCHLOTTER F, BECKER-GREENE D, et al. Sortilin enhances fibrosis and calcification in aortic valve disease by inducing interstitial cell heterogeneity[J]. European Heart Journal, 2023, 44(10):885-898.
[17] GUREVICH E, SEGEV Y, LANDAU D. Growth hormone and IGF1 actions in kidney development and function[J]. Cells, 2021, 10(12): 3371.
[18] SHIMABUKURO M. IGF-1 and cardiovascular and Non-Cardiovascular mortality risk in patients with chronic kidney disease:a model of “malnutritioninflammation-atherosclerosis syndrome”[J]. Journal of Atherosclerosis and Thrombosis, 2022, 29(8): 1138-1139.
[19] MORI K. Maintenance of skeletal muscle to counteract sarcopenia in patients with advanced chronic kidney disease and especially those undergoing hemodialysis[J]. Nutrients, 2021, 13(5): 1538.

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备注/Memo

备注/Memo:
基金项目：江苏省卫生健康委医学科研立项项目（S2022213）。
作者简介：封建华（1978-），男，本科，主任医师，研究方向：肾脏内科，E-mail：fenjianhua6832@126.com。
更新日期/Last Update: 2024-05-15